Vest and insurance issues

[skh]

We have BCBS insurance. My daughter has never been approved through them for the vest. It seems that they do not believe it is a medical necessity for her. Can you believe that? Needless to say Hill Rom has worked with us and my daughter does have the model 103. I am now trying to upgrade her to the smaller model 104. I just keep running into a brick wall. There are two others in our extended family who have cf and they have not been denied this equipment. They have the exact same insurance as we do, so what am I doing wrong?

I refuse to apologize that my daughter is doing great and has had no hospitalizations...isn't that what we want?! I also will not apologize that her PFT's have gone up each year since she was diagnosed 4 yrs. ago. This is because we are using preventative measures with her. Can't the insurance company see this? Do I have to wait until her health declines before they will agree that the vest is a good thing? I feel like they are telling me that she is not as important as the others.

Does anyone have any suggestions for me? I am now going back to her local cf physician and see if she will write another letter of necessity and hopefully this time they will approve it. But I just don't see that happening.

 

[skh]

We have BCBS insurance. My daughter has never been approved through them for the vest. It seems that they do not believe it is a medical necessity for her. Can you believe that? Needless to say Hill Rom has worked with us and my daughter does have the model 103. I am now trying to upgrade her to the smaller model 104. I just keep running into a brick wall. There are two others in our extended family who have cf and they have not been denied this equipment. They have the exact same insurance as we do, so what am I doing wrong?

I refuse to apologize that my daughter is doing great and has had no hospitalizations...isn't that what we want?! I also will not apologize that her PFT's have gone up each year since she was diagnosed 4 yrs. ago. This is because we are using preventative measures with her. Can't the insurance company see this? Do I have to wait until her health declines before they will agree that the vest is a good thing? I feel like they are telling me that she is not as important as the others.

Does anyone have any suggestions for me? I am now going back to her local cf physician and see if she will write another letter of necessity and hopefully this time they will approve it. But I just don't see that happening.

 

[skh]

We have BCBS insurance. My daughter has never been approved through them for the vest. It seems that they do not believe it is a medical necessity for her. Can you believe that? Needless to say Hill Rom has worked with us and my daughter does have the model 103. I am now trying to upgrade her to the smaller model 104. I just keep running into a brick wall. There are two others in our extended family who have cf and they have not been denied this equipment. They have the exact same insurance as we do, so what am I doing wrong?

I refuse to apologize that my daughter is doing great and has had no hospitalizations...isn't that what we want?! I also will not apologize that her PFT's have gone up each year since she was diagnosed 4 yrs. ago. This is because we are using preventative measures with her. Can't the insurance company see this? Do I have to wait until her health declines before they will agree that the vest is a good thing? I feel like they are telling me that she is not as important as the others.

Does anyone have any suggestions for me? I am now going back to her local cf physician and see if she will write another letter of necessity and hopefully this time they will approve it. But I just don't see that happening.

 

[Mathews]

Call your Legislator (either Senator or Representative) within your state and ask them to call BCBS and ask why??? BCBS I'm sure has an insurance lobbiest working with your State Legislature.

Sometimes this is very effective!! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[Mathews]

Call your Legislator (either Senator or Representative) within your state and ask them to call BCBS and ask why??? BCBS I'm sure has an insurance lobbiest working with your State Legislature.

Sometimes this is very effective!! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[Mathews]

Call your Legislator (either Senator or Representative) within your state and ask them to call BCBS and ask why??? BCBS I'm sure has an insurance lobbiest working with your State Legislature.

Sometimes this is very effective!! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[NoExcuses]

Call Dr. Warwick in Minnesota and get a copy of his information as to why the Vest is superior to manual CPT.. which can cut down on lung infections and can ultimately cut down on hospitalizations and save BCBS money

 

[NoExcuses]

Call Dr. Warwick in Minnesota and get a copy of his information as to why the Vest is superior to manual CPT.. which can cut down on lung infections and can ultimately cut down on hospitalizations and save BCBS money

 

[NoExcuses]

Call Dr. Warwick in Minnesota and get a copy of his information as to why the Vest is superior to manual CPT.. which can cut down on lung infections and can ultimately cut down on hospitalizations and save BCBS money

 

[blindhearted]

skh,
I am under BCBS (regional) and whenever we called they had no clue what the vest or CF was. Request a case manager. That way you will talk to one person. Their job is to be a middle man between you/ur doctor/the equipment company and the insurance company. They know who and how to talk to the right people. I was going around in circle until we got a case manager when I was trying to upgrade my vest. They told me what I needed from the doctor and the vest company. They opened a case and when I requested an upgrade, they closed the case when I got it and if there is something else that I need or having trouble with, she told me to contact her again. I know you will need a letter from the doctor stating why the vest is medically necessary. In the letter maybe they can put something in there about being pro-active in treatments and if the vest is not done then she is more at risk to get sick. Which causes more hospital visits, more money for the insurance company. when i upgraded my vest I was still in college, so that was on of the reason on why it was necessary was to have a smaller vest, more access to doing treatments on the go. I hope everything works out for you.

 

[blindhearted]

skh,
I am under BCBS (regional) and whenever we called they had no clue what the vest or CF was. Request a case manager. That way you will talk to one person. Their job is to be a middle man between you/ur doctor/the equipment company and the insurance company. They know who and how to talk to the right people. I was going around in circle until we got a case manager when I was trying to upgrade my vest. They told me what I needed from the doctor and the vest company. They opened a case and when I requested an upgrade, they closed the case when I got it and if there is something else that I need or having trouble with, she told me to contact her again. I know you will need a letter from the doctor stating why the vest is medically necessary. In the letter maybe they can put something in there about being pro-active in treatments and if the vest is not done then she is more at risk to get sick. Which causes more hospital visits, more money for the insurance company. when i upgraded my vest I was still in college, so that was on of the reason on why it was necessary was to have a smaller vest, more access to doing treatments on the go. I hope everything works out for you.

 

[blindhearted]

skh,
I am under BCBS (regional) and whenever we called they had no clue what the vest or CF was. Request a case manager. That way you will talk to one person. Their job is to be a middle man between you/ur doctor/the equipment company and the insurance company. They know who and how to talk to the right people. I was going around in circle until we got a case manager when I was trying to upgrade my vest. They told me what I needed from the doctor and the vest company. They opened a case and when I requested an upgrade, they closed the case when I got it and if there is something else that I need or having trouble with, she told me to contact her again. I know you will need a letter from the doctor stating why the vest is medically necessary. In the letter maybe they can put something in there about being pro-active in treatments and if the vest is not done then she is more at risk to get sick. Which causes more hospital visits, more money for the insurance company. when i upgraded my vest I was still in college, so that was on of the reason on why it was necessary was to have a smaller vest, more access to doing treatments on the go. I hope everything works out for you.

 

[skh]

Thank you for your help with this. I will be using all of your suggestions.

 

[skh]

Thank you for your help with this. I will be using all of your suggestions.

 

[skh]

Thank you for your help with this. I will be using all of your suggestions.

 

[sdelorenzo]

I also was trying to upgrade my daughters vest, but I gave up after I realized that we would owe $6,000. I am glad now that we didn't upgrade. I spoke to a respiratory therapist who used to work for Hill-rom and he explained that the earlier version is Dr. Warwick's original, better design. The newer smaller version did not have a patent on the vest, so they could not use the same wave design. Therefore, the bigger vest machine, while more difficult to travel with should work better. I also read that Dr. Warwick also told one of his patient this recently. Just something to consider.
Sharon, mom of Sophia, 5 and Jack, 3 both with cf

 

[sdelorenzo]

I also was trying to upgrade my daughters vest, but I gave up after I realized that we would owe $6,000. I am glad now that we didn't upgrade. I spoke to a respiratory therapist who used to work for Hill-rom and he explained that the earlier version is Dr. Warwick's original, better design. The newer smaller version did not have a patent on the vest, so they could not use the same wave design. Therefore, the bigger vest machine, while more difficult to travel with should work better. I also read that Dr. Warwick also told one of his patient this recently. Just something to consider.
Sharon, mom of Sophia, 5 and Jack, 3 both with cf

 

[sdelorenzo]

I also was trying to upgrade my daughters vest, but I gave up after I realized that we would owe $6,000. I am glad now that we didn't upgrade. I spoke to a respiratory therapist who used to work for Hill-rom and he explained that the earlier version is Dr. Warwick's original, better design. The newer smaller version did not have a patent on the vest, so they could not use the same wave design. Therefore, the bigger vest machine, while more difficult to travel with should work better. I also read that Dr. Warwick also told one of his patient this recently. Just something to consider.
Sharon, mom of Sophia, 5 and Jack, 3 both with cf

 

[Alyssa]

Ditto to Danyell's post -- I have used a case manager for getting approval on a specific item, it did help.

We are currently battling with Cigna about a vest as well. My daughter's PFT's are also good and have increased since using the vest. We have been denied and Hill-Rom has filed an appeal. They did all the leg work on getting another letter out of the doctor to "beef up" our case. No word back yet, but it's only been a couple of weeks.

From what we can tell right now, Cigna's problem with purchasing the vest is they didn't see why she couldn't use the flutter or acapella. She cannot use either of these because they make her dizzy.

Also, does your daughter have reflux? Hill-Rom told me that it is almost impossible for an insurance company to be able to deny if the child has reflux because many of the manual CPT positions have to be done in a head down position -- it isn't safe. That's just one more thing for putting into a letter of medical necessity if it applies.

 

[Alyssa]

Ditto to Danyell's post -- I have used a case manager for getting approval on a specific item, it did help.

We are currently battling with Cigna about a vest as well. My daughter's PFT's are also good and have increased since using the vest. We have been denied and Hill-Rom has filed an appeal. They did all the leg work on getting another letter out of the doctor to "beef up" our case. No word back yet, but it's only been a couple of weeks.

From what we can tell right now, Cigna's problem with purchasing the vest is they didn't see why she couldn't use the flutter or acapella. She cannot use either of these because they make her dizzy.

Also, does your daughter have reflux? Hill-Rom told me that it is almost impossible for an insurance company to be able to deny if the child has reflux because many of the manual CPT positions have to be done in a head down position -- it isn't safe. That's just one more thing for putting into a letter of medical necessity if it applies.